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Weaning mechanical ventilation

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https://www.readbyqxmd.com/read/29776707/unplanned-extubations-in-an-intensive-care-unit-findings-from-a-critical-incident-technique
#1
Matteo Danielis, Simona Chiaruttini, Alvisa Palese
BACKGROUND: Patients on mechanical ventilation are at risk of experiencing a potentially life-threatening unplanned extubation in the intensive care unit, which can lead to arrhythmias, bronchial aspiration, difficulty in reintubation or even sudden cardiac arrest. Although incidence and outcomes of the phenomenon have been documented in several quantitative studies, no studies have investigated the antecedents as experienced by critical care nurses. OBJECTIVES: To gain a greater understanding of the antecedents of unplanned extubations...
May 15, 2018: Intensive & Critical Care Nursing: the Official Journal of the British Association of Critical Care Nurses
https://www.readbyqxmd.com/read/29774445/pregnancy-complicated-by-influenza-a-ards-requiring-consecutive-vv-ecmo-treatment-with-successful-vaginal-delivery
#2
Peter Radsel, Vojka Gorjup, Anja Jazbec, Rihard Knafelj, Miha Lucovnik, Gorazd Kavsek, Lilijana Kornhauser Cerar, Marko Noc
A 29-year-old woman presented with influenza A ARDS at 23+0 weeks of gestation. Mechanical ventilation failed and VV-ECMO was started in a non-ECMO hospital. Transportation was performed on ECMO. Within 5 days ECMO weaning was successful. Fetal condition was stable, and decision to continue pregnancy was taken. However, second VV-ECMO was needed due to ventilator-associated pneumonia. At 25+6 weeks, the patient spontaneously delivered a neonate vaginally. Patient's condition improved, and ECMO could be removed 10 days postpartum...
May 17, 2018: Journal of Artificial Organs: the Official Journal of the Japanese Society for Artificial Organs
https://www.readbyqxmd.com/read/29771711/respiratory-muscle-effort-during-expiration-in-successful-and-failed-weaning-from-mechanical-ventilation
#3
Jonne Doorduin, Lisanne H Roesthuis, Diana Jansen, Johannes G van der Hoeven, Hieronymus W H van Hees, Leo M A Heunks
BACKGROUND: Respiratory muscle weakness in critically ill patients is associated with difficulty in weaning from mechanical ventilation. Previous studies have mainly focused on inspiratory muscle activity during weaning; expiratory muscle activity is less well understood. The current study describes expiratory muscle activity during weaning, including tonic diaphragm activity. The authors hypothesized that expiratory muscle effort is greater in patients who fail to wean compared to those who wean successfully...
May 16, 2018: Anesthesiology
https://www.readbyqxmd.com/read/29768017/the-signaling-network-resulting-in-ventilator-induced-diaphragm-dysfunction
#4
Huibin Tang, Joseph B Shrager
Mechanical ventilation (MV) is a life-saving measure for those incapable of adequately ventilating or oxygenating without assistance. Unfortunately, even brief periods of MV result in diaphragm weakness (i.e., "ventilator-induced diaphragm dysfunction" - VIDD) that may render it difficult to wean the ventilator. Prolonged MV is associated with cascading complications and is a strong risk factor for death. Thus, prevention of VIDD may have a dramatic impact on mortality rates. Here, we summarized the current understanding of the pathogenic events underlying VIDD...
May 16, 2018: American Journal of Respiratory Cell and Molecular Biology
https://www.readbyqxmd.com/read/29762314/effectiveness-of-dexmedetomidine-versus-propofol-on-extubation-times-length-of-stay-and-mortality-rates-in-adult-cardiac-surgery-patients-a-systematic-review-and-meta-analysis
#5
John Nguyen, Noel Nacpil
OBJECTIVE: To determine the effects of dexmedetomidine versus propofol on extubation time, intensive care unit (ICU) length of stay, total hospital length of stay and in-hospital mortality rates in cardiac surgery patients. INTRODUCTION: Recovery from cardiovascular surgery involves weaning from mechanical ventilation. Mechanical ventilation decreases the work of breathing for patients by inhaling oxygen and exhaling carbon dioxide via a ventilator or breathing machine...
May 2018: JBI Database of Systematic Reviews and Implementation Reports
https://www.readbyqxmd.com/read/29760926/diffuse-endobronchial-metastasis-from-sigmoid-carcinoma-presenting-as-wheezing-and-respiratory-failure
#6
Nattawat Jantarangsi, Poonchavist Chantranuwatana, Naricha Chirakalwasan
A 66-year-old Thai man with underlying asthma, history of traumatic right haemothorax, and sigmoid carcinoma with bladder invasion developed productive cough, whitish sputum, dyspnoea, and wheezing for 2 months. Physical examination showed generalized expiratory wheezing in both lungs. Computed tomography scan of the chest revealed diffuse thickening of bronchial wall, predominantly at lower lobes; several various sizes of pulmonary nodules; diffuse interlobular septal thickening; multiple enlarged mediastinal lymph nodes and hilar lymph nodes; and right pleural effusion...
July 2018: Respirology Case Reports
https://www.readbyqxmd.com/read/29746721/melatonin-for-the-promotion-of-sleep-in-adults-in-the-intensive-care-unit
#7
REVIEW
Sharon R Lewis, Michael W Pritchard, Oliver J Schofield-Robinson, Phil Alderson, Andrew F Smith
BACKGROUND: Patients in the intensive care unit (ICU) experience sleep deprivation caused by environmental disruption, such as high noise levels and 24-hour lighting, as well as increased patient care activities and invasive monitoring as part of their care. Sleep deprivation affects physical and psychological health, and patients perceive the quality of their sleep to be poor whilst in the ICU. Artificial lighting during night-time hours in the ICU may contribute to reduced production of melatonin in critically ill patients...
May 10, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29744245/reliability-of-passive-leg-raising-stroke-volume-variation-and-pulse-pressure-variation-to-predict-fluid-responsiveness-during-weaning-from-mechanical-ventilation-after-cardiac-surgery-a-prospective-observational-study
#8
Christoph Karl Hofer, Martin Geisen, Sonja Hartnack, Omer Dzemali, Michael Thomas Ganter, Andreas Zollinger
Objective: During assisted ventilation and spontaneous breathing, functional haemodynamic parameters, including stroke volume variation (SVV) and pulse pressure variation (PPV), are of limited value to predict fluid responsiveness, and the passive leg raising (PLR) manoeuvre has been advocated as a surrogate method. We aimed to study the predictive value of SVV, PPV and PLR for fluid responsiveness during weaning from mechanical ventilation after cardiac surgery. Methods: Haemodynamic variables and fluid responsiveness were assessed in 34 patients...
April 2018: Turkish Journal of Anaesthesiology and Reanimation
https://www.readbyqxmd.com/read/29743094/feasibility-and-safety-of-low-flow-extracorporeal-co-2-removal-managed-with-a-renal-replacement-platform-to-enhance-lung-protective-ventilation-of-patients-with-mild-to-moderate-ards
#9
Matthieu Schmidt, Samir Jaber, Elie Zogheib, Thomas Godet, Gilles Capellier, Alain Combes
BACKGROUND: Extracorporeal carbon-dioxide removal (ECCO2 R) might allow ultraprotective mechanical ventilation with lower tidal volume (VT) (< 6 ml/kg predicted body weight), plateau pressure (Pplat ) (< 30 cmH2 O), and driving pressure to limit ventilator-induced lung injury. This study was undertaken to assess the feasibility and safety of ECCO2 R managed with a renal replacement therapy (RRT) platform to enable very low tidal volume ventilation of patients with mild-to-moderate acute respiratory distress syndrome (ARDS)...
May 10, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29741919/efficacy-of-acupuncture-treatment-for-improving-the-respiratory-status-in-patients-receiving-prolonged-mechanical-ventilation-in-intensive-care-units-a-retrospective-observational-study
#10
Jun Matsumoto-Miyazaki, Hiroaki Ushikoshi, Kodai Suzuki, Nagisa Miyazaki, Takahide Nawa, Hideshi Okada, Shozo Yoshida, Ichijiro Murata, Shinji Ogura, Shinya Minatoguchi
BACKGROUND AND OBJECTIVE: Patients in critical care settings often require prolonged mechanical ventilation (MV) therapy and, occasionally, they cannot be weaned from MV. The authors evaluated the efficacy of acupuncture treatment for improving the respiratory status and promoting successful weaning from prolonged MV in patients at intensive care units (ICUs). DESIGN: Retrospective observational study. SETTING: Gifu University Hospital, Gifu, Japan...
May 9, 2018: Journal of Alternative and Complementary Medicine: Research on Paradigm, Practice, and Policy
https://www.readbyqxmd.com/read/29732188/weaning-from-veno-venous-extracorporeal-membrane-oxygenation-how-i-do-it
#11
REVIEW
Lars M Broman, Maximilian V Malfertheiner, Andrea Montisci, Federico Pappalardo
Veno-venous extracorporeal membrane oxygenation (VV ECMO) is a rescue treatment for acute respiratory distress syndrome (ARDS) failing protective mechanical ventilation. It temporarily provides proper gas exchange: hypoxia is treated by adjusting the blood flow rate and fraction in spired oxygen over the ventilator (FiO2 ) on the extracorporeal membrane oxygenation (ECMO) circuit while CO2 removal is regulated by the ECMO fresh gas flow. Therefore, ventilator settings can be gradually reduced allowing the lungs to rest and recover...
March 2018: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/29732176/oxygenator-performance-and-artificial-native-lung-interaction
#12
REVIEW
Francesco Epis, Mirko Belliato
During extracorporeal membrane oxygenation (ECMO), oxygen (O2 ) transfer (V'O2 ) and carbon dioxide (CO2 ) removal (V'CO2 ) are partitioned between the native lung (NL) and the membrane lung (ML), related to the patient's metabolic-hemodynamic pattern. The ML could be assimilated to a NL both in a physiological and a pathological way. ML O2 transfer (V'O2 ML) is proportional to extracorporeal blood flow and the difference in O2 content between each ML side, while ML CO2 removal (V'CO2 ML) can be calculated from ML gas flow and CO2 concentration at sweep gas outlet...
March 2018: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/29721319/successful-ventilator-weaning-following-vascular-bypass-in-patient-with-vascular-tracheobronchial-compression
#13
Kei Sonehara, Toshitaka Shomura, Masanori Yasuo, Atsuhito Ushiki, Hiroshi Yamamoto, Masayuki Hanaoka
A 74-year-old man, who had undergone thoracoplasty for tuberculous sequelae 54 years earlier, was referred to our hospital with a chief complaint of dyspnea. He had recently received mechanical ventilation due to pneumonia. However, although the pneumonia had improved, extubation was prevented by the presence of hypercapnic respiratory failure with tracheal stenosis due to compression of the right aortic arch and the left common carotid artery. Bypass surgery was performed, during which the left subclavian artery was placed over the left common carotid artery...
July 2018: Respirology Case Reports
https://www.readbyqxmd.com/read/29718154/early-extubation-is-associated-with-improved-early-outcome-after-extracardiac-total-cavopulmonary-connection-independently-of-duration-of-cardiopulmonary-bypass
#14
Stanislav Ovroutski, Peter Kramer, Sarah Nordmeyer, Mi-Young Cho, Matthias Redlin, Oliver Miera, Joachim Photiadis, Felix Berger
OBJECTIVES: Strict patient selection, short cardiopulmonary bypass (CPB) time and short mechanical ventilation are well-recognized aspects of optimizing the postoperative course after total cavopulmonary connection. In this study, we evaluated the influence of our early postoperative extubation strategy in our population of Fontan patients over the past 2 decades. METHODS: Early postoperative course was evaluated retrospectively in 211 consecutive patients, who were selected for total cavopulmonary connection in our institution between 1995 and 2015...
April 27, 2018: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/29717916/risk-factors-associated-with-the-development-of-acquired-airway-disease-after-congenital-heart-surgery-a-retrospective-cohort-study
#15
Andrew J Matisoff, Pranathi Ari, David Zurakowski, Alexandra G Espinel, Nina Deutsch, Brian K Reilly
OBJECTIVE: In this single-center, retrospective review, we sought to determine the risk factors associated with the development of severe acquired airway disease (AAD; vocal cord paralysis [VCP] or subglottic stenosis [SGS]) in pediatric patients who had undergone surgery for congenital heart disease (CHD) with cardiopulmonary bypass. All patients who required surgical treatment for CHD using cardiopulmonary bypass at our institution between 2010 and 2015 were reviewed. We defined severe AAD as either clinically significant VCP, SGS, or both, requiring consultation with the otolaryngology (ENT) service for evaluation...
April 1, 2018: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29714351/correction-to-use-of-diaphragm-thickening-fraction-combined-with-rapid-shallow-breathing-index-for-predicting-success-of-weaning-from-mechanical-ventilator-in-medical-patients
#16
Pattarin Pirompanich, Sasithon Romsaiyut
[This corrects the article DOI: 10.1186/s40560-018-0277-9.].
2018: Journal of Intensive Care
https://www.readbyqxmd.com/read/29708916/venovenous-extracorporeal-membrane-oxygenation-to-prolong-pregnancy-a-case-report
#17
Omar Alyamani, Michael A Mazzeffi, Shobana Bharadwaj, Jessica H Galey, Ruofan Yao, Nirav G Shah, Andrew M Malinow
We report a gravida in fulminant acute respiratory distress syndrome, mechanically ventilated at 27 weeks estimated gestational age, who further deteriorated into severe combined hypercarbic, hypoxemic respiratory failure. At 30 weeks estimated gestational age, she was placed on venovenous extracorporeal membrane oxygenation (ECMO) because of refractory respiratory failure. Her physical status improved without fetal deterioration. She was managed expectantly in an effort to allow continued fetal maturation...
May 1, 2018: A&A practice
https://www.readbyqxmd.com/read/29699834/respiratory-muscle-strength-and-state-of-consciousness-values-measured-prior-to-the-decanulation-in-different-levels-of-complexity-a-longitudinal-prospective-case-series-study
#18
L Diaz-Ballve, D Villalba, M Andreu, M Escobar, G Morel-Vulliez, J Lebus, E Rositi
OBJECTIVE: To describe the variables related to effective cough capacity and the state of consciousness measured prior to decannulation and compare their measured values between the different areas of care such as the Intensive Care Unit (ICU), General ward and Mechanical Ventilation Weaning and Rehabilitation Centers (MVWRC). Secondarily analyze the evolution of patients once decannulated. DESIGN: Case series, longitudinal and prospective. SCOPE: Multicentric 31 ICUs (polyvalent) and 5 MVWRC...
April 23, 2018: Medicina Intensiva
https://www.readbyqxmd.com/read/29687440/hypophosphatemia-and-duration-of-respiratory-failure-and-mortality-in-critically-ill-patients
#19
C K Federspiel, T S Itenov, K Thormar, K D Liu, M H Bestle
BACKGROUND: Hypophosphatemia has been associated with prolonged duration of respiratory failure and increased mortality in critically ill patients, but there is very limited evidence supporting the negative effects of low phosphate. We examined the association between hypophosphatemia at ICU admission and time to successful weaning and 28-day mortality. METHODS: This was a cohort study that included all mechanically ventilated adult patients admitted to the ICU in 2013 at Nordsjaellands Hospital...
April 23, 2018: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/29687276/diaphragm-function-and-weaning-from-mechanical-ventilation-an-ultrasound-and-phrenic-nerve-stimulation-clinical-study
#20
Martin Dres, Ewan C Goligher, Bruno-Pierre Dubé, Elise Morawiec, Laurence Dangers, Danielle Reuter, Julien Mayaux, Thomas Similowski, Alexandre Demoule
BACKGROUND: Diaphragm dysfunction is defined by a value of twitch tracheal pressure in response to magnetic phrenic stimulation (twitch pressure) amounting to less than 11 cmH2 O. This study assessed whether this threshold or a lower one would predict accurately weaning failure from mechanical ventilation. Twitch pressure was compared to ultrasound measurement of diaphragm function. METHODS: In patients undergoing a first spontaneous breathing trial, diaphragm function was evaluated by twitch pressure and by diaphragm ultrasound (thickening fraction)...
April 23, 2018: Annals of Intensive Care
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